Should We Repeat Imaging If Clinical Suspicion is High in Axial Spondyloarthritis, A Case Report.
Received Date: October 03, 2020; Published Date: October 30, 2020
Currently there is an average delay to diagnosis of eight and a half years in axial spondyloarthritis (AxSpA) in the United Kingdom often leading to detrimental consequences for patients. The 2009 ASAS criteria for the diagnosis of Axial Spondyloarthritis support the use of Magnetic resonance imaging of the spine and sacroiliac joints in early diagnosis and are said to enhance diagnostic accuracy . At times in clinic we are presented with patients who have strong features of Inflammatory back pain (IBP) that may have normal inflammatory markers and a normal MRI which pose diagnostic and treatment confusion.
We present a case of a 28-year-old female who presented to the community rheumatology service with a three-year history of inflammatory back pain and widespread arthralgia and fatigue. She was subsequently found to be HLA-B27 negative and her CRP was 1. Initial conventional radiographs of the sacroiliac joints were normal and initial whole spine and sacrolliac MRI showed no romanus lesions in the spine and only subtle right anterior bony oedema which was thought not to be of clinical significance. Initially the BASDAI score was 3.4. The patient continued to have strong symptoms of Axial Spondyloarthritis despite a largely negative imaging and normal CRP. We planned to treat her with Arcoxia, Proton pump inhibitors and yoga/Stretching exercises and repeat the MRI after 6 months .Repeat imaging demonstrated moderate bilateral sacroilliatis with both sacral and illium anterior bony oedema without any romanus lesions in the spine. BASDAI improved to 2.4 with the use of Etoricoxib and regular stretching exercises.
The case suggests that in the right clinical setting with strong features of Axial Spondyloarthritis repeat scanning may be beneficial to diagnosis and treatment which is currently suggested in the NICE guidelines.